Paternity Notification Affidavit

Putative Father’s Name: __________________Biological Mother’s Name:_____________________

PATERNITY NOTIFICATION AFFIDAVIT, completed by ( )Biological Mother ( ) Legal Guardian

This form is REQUIRED to establish paternity for the child listed based on DNA genetic testing with a minimum Paternity Index of 2,000 to 1. Take this information to the Attorney of your choice to create an enforceable document based on your state laws with emphasis on statutes for perjury, fraud and misrepresentation.

Child’s Name on Birth Certificate:_______________________________ Date of Birth:___/____/____

Child was conceived in: City, State:_____________________________

Hospital where child was born:__________________________ City, State:__________________
Date of Conception: ___/___/___ , Original Est. Delivery Date: __/__/__ Length of pregnancy at birth (gestational age in weeks)____________

Marital Status at child’s birth: Mother: _________________________ Putative Father: ________________________

If biological mother was married at birth, to whom?: _______________________________________

POSSIBLE FATHER(s):

Is the putative father “the only possible biological father of the child?”__________________ Fill in YES or NO

Did the biological Mother have sexual intercourse with anyone other than the putative father within 60 days of becoming pregnant? _____________ Fill in YES or NO

If so, name:_________________________ Address:__________________________

If so, name:_________________________ Address:___________________________

Did the biological mother inform the listed possible fathers in writing, of this child? ( ) Yes ( ) No
If so, when and attach proof? ________________ If not, why not? _________________________
___________________________________________________

Has the Biological Mother ever named anyone else as the father of this child? ( ) Yes ( ) No

If yes, name: ____________________ Address: ________________________

Has DNA paternity testing ever been done on this putative father for this child? ( ) Yes ( ) No
What were the results?_______________________Paternity Index is_____________%_ (Attach copy of results)

Has DNA paternity testing ever been done on any other male for this child ? ( ) Yes ( ) No,
What were the results?_______________________Paternity Index is_____________%_ (Attach copy of results)

Personally appeared before the undersigned officer, duly authorized to administer oaths, the undersigned who states under oath that the foregoing statements are true and correct. I understand that medical tests will be required to confirm actual paternity for the above child. I will cooperate with genetic testing and all legal actions to establish paternity for the child.

So sworn and affirmed,

Mother / Guardian’s Signature:_______________________________ SSN _____-____-_____ Date:____/____/____

Notary Public Signature: __________________________ Commission Expiration Date:____/____/_____

NOTARY SEAL:

PATERNITY NOTIFICATION AFFIDAVIT form created by Carnell Smith

Maybe freely copied or used provided the attribution line is kept intact.

AGREEMENT & AFFIDAVIT

I understand the criminal penalties for making false statements and false swearing and do hereby attest to the truthfulness of the information provided. [False swearing is punishable by a fine, by imprisonment or both.] Insert your states statutes for perjury, false swearing, misrepresentation and fraud.

I understand that copies of this notarized Paternity Notification Affidavit must be sent to the putative father and all possible fathers listed on this affidavit via certified mail + restricted delivery + return receipt or similar service that requires Identification and signature on delivery.

ESTABLISHING PATERNITY FOR THE CHILD LISTED

I acknowledge that I am the biological mother or legal guardian of the child listed in this Affidavit. This Paternity Acknowledgment Affidavit has been given of my own free will and volition, and I understand that under the Laws of the State of __________, and at some time in the future, I may be liable to furnish support for the child named herein, until said child has emancipated.

I understand that the child(ren) and I will be required to submit to genetic testing for paternity determination, and am so willing to cooperate, to establish paternity for the child. Except for legally adopted children and certain cases of births resulting from artificial insemination. See Paternity Testing section for more information.

PATERNITY TESTING: If paternity has not been determined by genetic testing, testing will be required to determine paternity. If the putative father is the biological father, the biological mother or legal guardian will have right of action for child support except for non-adopted children and certain pregnancies resulting from unauthorized artificial insemination. In all cases of artificial insemination, the mother or legal guardian must provide copy of notarized written consent to the procedure, signed by the biological mother, the putative father and the treating physician to have right of action for child support.

COST OF TESTING: Initial fees for genetic testing will be split on a 50 percent basis by the biological mother or legal guardian and the putative father. If the putative father is not the biological father, he shall be reimbursed in full by the initiating party for all costs associated with defending the false allegation of paternity.

RELEASE OF SUPPORT:

If any of the following conditions apply to the putative father, he shall be released from all responsibility for the child, including child support, arrears and other expenses:

The putative father is not the biological father based on paternity index below a ratio of 1,000 to 1.

The putative father is not the legally adopted father.

The putative father did not consent (written and notarized) to the artificial insemination, signed by his Wife, the biological mother and the treating physician. If this child is born by a surrogate mother using the putative father’s sperm then his wife shall have cause of action for child support purposes.

PROOF OF NON-PATERNITY: If the putative father meets any of the criteria above for release of support, he will receive an official order of non-paternity and full release of all obligations for the child listed on this form.

PATERNITY NOTIFICATION AFFIDAVIT form created by Carnell Smith

Maybe freely copied or used provided the attribution line is kept intact.

Paternity Fraud is a crime, crime does NOT PAY and neither should the victim!